Shift in survivorship care delivery.
Authors: Elizabeth Boutin McGrath, Jennifer Willyard, Maya Langa, Sarah K. Walsh, Andrea B Buccellato
Journal: Journal of Clinical Oncology (2022)

230 Background: Survivorship care often occurs within a single visit at the end of treatment to discuss a treatment summary and/or survivorship care plan with a patient. With increased understanding of both immediate and long-term effects of cancer and cancer treatment we need to consider support for the patient from the time of diagnosis through the end of the patient’s life. In this quality improvement (QI) initiative, a team of survivorship stakeholders utilized survey and focus group methodology to develop a set of recommendations to support a large, academic medical center in a rural setting to move toward this holistic notion of survivorship care. Methods: Surveys regarding experience with survivorship care were deployed to oncology providers, allied health providers, and patients and care partners. Surveys were deployed via a web-based survey tool using email groups and lists developed by the oncology department, as well as printed handouts with the survey URL and a QR code available to patients during clinic visits. A focus group was conducted with oncology APPs to discuss findings and to develop recommendations to support survivorship care delivery. Results: Responses received from 59 patients, 20 care partners, 24 allied health providers, and 19 providers. Over half (52.6%) of patients and care partners indicated that survivorship services were “very important” to their care, with less than 10 respondents (11.5%) indicating that they were “not at all important.” Providers indicated that they do discuss and/or provide survivorship support to their patients (84.2% of respondents), but almost 80% indicated that they were only somewhat knowledgeable (36.8%) or not knowledgeable at all (42.1%) about survivorship services available to patients and care partners. Both allied health and providers indicated that documenting survivorship care was complex. Only 12.5% of providers indicated that patients had a formal survivorship visit; instead, providers indicated that survivorship care is incorporated into routine follow-up visits (75%) and/or active treatment visits (50%). Both allied health (60.0%) and providers (69.2%) indicated that documentation, if done at all, was entered through a free text note. Many acknowledged that this made data tracking, whether for continuity of care or program analysis purposes, labor-intensive. Conclusions: This QI initiative revealed the need for two supportive mechanisms to facilitate the shift from survivorship care that’s limited to a dedicated visit type or tied to a specific document to survivorship care that is woven into all aspects of a patient’s treatment and life beyond treatment. The first mechanism is a robust set of informational resources to ensure providers are knowledgeable about the services that are available to their patients and the referral mechanisms for those services. The second is a mechanism within the EHR to allow survivorship notes to be entered into any visit type and be extracted easily from the system.